New procedure offers alternative to lower limb amputation

On Oct. 8, UK King’s Daughters became the first hospital in the state of Kentucky – and the only hospital in the region – to offer a new minimally invasive procedure for the treatment of chronic limb-threatening ischemia (CLTI) for patients whose disease cannot be treated using standard surgical procedures.

The LimFlow procedure was performed by UK King’s Daughters vascular surgeon David Dockray, M.D. Vascular surgeon Omran Abul-Khoudoud, M.D., assisted.

CLTI is the severe, end-stage of peripheral artery disease. In CLTI, the arteries delivering blood and oxygen to the lower extremities are blocked, leading to severe pain both when walking and at rest, functional impairment, ulcers, non-healing wounds, tissue death, gangrene and ultimately amputation.

During the LimFlow procedure, the surgeon makes two small incisions, one in the groin to access the tibial artery, and one in the foot to access a deep vein. Catheters are inserted into the vessels and threaded through the body to an area above the blockage, typically in the calf area. Specialized instruments bridge from the artery to the vein and the opening is widened using a balloon catheter.

The LimFlow device is deployed and grafts placed inside the vessels to permanently connect the artery and vein.

While blood flow through the vein to the lower leg and foot begins immediately, ongoing monitoring and care of non-healing wounds must be maintained while revascularization takes place, typically over six to 12 weeks.

About two-thirds of patients participating in the Promise II study, which evaluated the safety and effectiveness of deep vein arterialization and the LimFlow system, were amputation free after 6 months. Following the procedure, wounds were completely healed in 25% of patients and were in process of healing in 51% of patients. LimFlow was approved by the U.S. Food and Drug Administration in September 2023.

About 12% of the U.S. population suffers from CLTI, and most patients with CLTI also have cardiovascular disease. The incidence of CLTI is growing across the U.S. as the population ages and rates of diabetes and arterial sclerosis increase, Dr. Dockray said.

As many as 30% of patients with CLTI end up with an amputation, he noted. “Amputation itself, as well as the prospect of maybe having to have one, is devastating. This new procedure offers hope to patients who, up until now, had none. So I am thrilled to be able to offer this procedure at UK King’s Daughters.”

If you have peripheral artery disease, non-healing wounds, or CLTI and would like to know more about LimFlow, please call UK King’s Daughters Tri-State Vascular Specialists at (606) 326-1675. New patients are welcome; a provider referral is not required.

THE LIMFLOW TEAM, from left: Amber Spurlock, R.N.; Michael Adkins, RT (R)(Vi); Omran Abul-Khoudoud, M.D.; Lindsay Short, senior lead vascular sonographer; David Dockray, M.D.; Emily Rakes, RT (R)(Vi); Chandra Brammer, RT (R)(Vi).